MSK medicine encompasses a wide range of conditions including degenerative disorders, soft tissue or spinal problems, inflammatory joint diseases and even rarer connective tissue diseases (CTD’s), vasculitis and other ‘immunological based’ syndromes. Management of MSK conditions is often multi-disciplinary and shared between GPs, rheumatologists, orthopaedic surgeons, specialist nurses, radiologists, physiotherapists, podiatrists and occupational therapists. Gaining a perspective of what these specialties do and how they work together will be helpful to you. It is also important to know when to refer a patient to a specialist consultant, when not to, and what the alternative management options are.

The vast majority of MSK conditions are managed in community care settings, including primary care. MSK problems are extremely common and are estimated to account for 20% of consultations in general practice. Even if you are not going to be a GP (50% of doctors), it is very likely that you will deal with MSK problems in a range of environments including general wards.

On your placement with MSK, your timetable will include observing and participating in clinics in a variety of city-wide community-based locations.

Your community MSK care placement will largely be a clinic-based learning experience. You will not be designated a specific clinician to work with during this placement (although you will have a named placement lead) and you will be slotted into different clinics run by our team of advanced practice physiotherapy and consultant clinicians with their own specific interests and areas of expertise.

You will be expected to undertake MSK examinations, discuss clinical and diagnostic findings in relation to MSK, discuss prognosis and treatment planning, as well as watching and learning from our experienced clinicians. You will not be expected to keep electronic patient records – personal access to System One will not be set up for you while on this work-based clinical placement.

Clinical placement aims

To introduce students to the basic principles behind good history taking and clinical examination of patients with a musculoskeletal disorders presenting in community setting.

To understand the scale of musculoskeletal care in the community setting and the impact of musculoskeletal disorders on individuals, the healthcare system and wider society.

To be able to devise a broad management plan for common musculoskeletal conditions that is personalised to a patient’s needs and circumstances in the community

To demonstrate the following skills:

• Competence in taking a focused and personalised clinical history for patients with different types of MSK condition (in order to differentiate types of MSK condition, understand personal impact, plan shared goals, monitor effects of treatment, and identify complications).
• Ability to perform a competent and targeted MSK clinical examination of peripheral joints and soft tissues (particularly knees, hips, shoulders)
• Ability to perform a competent and targeted MSK spinal clinical examination (including neurological examination)
• Ability to interpret findings from clinical history and physical examination to make an appropriate differential diagnosis and explain this in an appropriate and meaningful way to the patient.
• Competence in presenting clinical MSK cases to peers and senior colleagues.
• Basic interpretation of radiological imaging, and ability to discuss relevance of imaging and lab test reports in relation to clinical presentations.
• Ability to work independently and as part of a team.
• Professional and effective interaction with patients and their families and carers, clinicians and non-clinical support staff.

Attitudes

The student acknowledges the impact of MSK conditions and symptoms on the lives of patients and their family, friends and carers.

The student has an appreciation of and is able to apply ethical principles in their clinical practice.

The student appreciates diversity and the needs of different patients (for example culture, language, age, socioeconomic status).

A further list of specific competencies and conditions for MSK can be found in the Campus to Clinic Year 5 Study Guide and Padlet.

You will be invited by LTHT to attend an induction and welcome lecture where you will be given more detailed information about your community placement and what to expect.

Spinal assessment clinics

Led by advanced practice physiotherapists, these clinics are for the assessment of patients with spinal problems that may be complex, require imaging or require, require surgical opinion, or require onward referral to a specialist service. The clinics are offered in a variety of locations across Leeds to facilitate access for patients.

Patients assessed in these clinic present with a range of spinal problems, including radiculopathy, spinal stenosis, cervical myelopathy, persistent spinal pain. An important part of the assessment process is screening for signs and symptoms suggestive of serious pathologies such as spinal infection, cancer, fractures, and spondyloarthropathy.

Spinal injection clinics

Patients with radicular leg symptoms who may benefit from spinal injection can be referred to the spinal injection clinic by the MSK clinical team. Our MSK consultant physician leads these clinics, performing transforaminal and caudal epidural steroid injections under x-ray guidance.

Urgent spinal assessment clinics

Our advanced practice spinal physiotherapists and a spinal surgical consultant from Leeds Teaching Hospitals run a joint clinic to review and plan care for patients with spinal problems that may need urgent surgical intervention. Patients attending this clinic are reviewed jointly by the app and consultant and may be consented and directly booked for surgery if appropriate. Decisions may be made regarding alternative care or monitoring if more appropriate.

Peripheral assessment clinics

Led by advanced practice physiotherapists, these clinics are for the assessment of patients with complex MSK problems that may require imaging, require surgical opinion, require an intervention such as steroid injection, or require onward referral to a specialist service. They are also used for other members of the team to access second opinions from our more experienced clinicians. The clinics are offered in a variety of locations across Leeds to facilitate access for patients.

Patients assessed in these clinic present with a range of musculoskeletal problems, including tendinopathy, joint problems such as instability, peripheral nerve problems such as ulnar neuropathy or carpal tunnel syndrome, persistent or widespread pain. An important part of the assessment process is screening for signs and symptoms suggestive of serious pathologies such as joint infection, cancer, fractures, and inflammatory conditions.

Ultrasound clinics

These clinics are led by advanced practice physiotherapists who have undertaken additional training in ultrasound (US) imaging. The US imaging is used when felt appropriate by the clinician as an adjunct in the clinical assessment and management of patients with MSK conditions, particularly those with shoulder and tendon problems.

Online multidisciplinary team case discussion clinics

The community MSK service has strong links with secondary care. Our advanced practice physiotherapists work closely with secondary care consultants and clinicians. They have established several multidisciplinary case discussion meetings to guide and support effective and efficient management of patients with a range of musculoskeletal problems. These include a knee MDT, hip MDT, spinal MDT, and persistent pain MDT. The MDT meetings are used to discuss cases where a surgical or specialist opinion is required.

We expect you to attend 100% of sessions on the programme as a mark of respect for your colleagues and particularly your patients. Failure to attend, or absence without permission, can have serious consequences and may result in you being excluded from the University.

• MBChB attendance and absence: Student guidance 

If you are unwell and unable to attend any of the clinics allocated in your timetable, please contact the Medical Education team at lcht.medicaleducation@nhs.net to let them know as soon as possible, and notify your placement office.

The School of Medicine, in collaboration with placement providers and students, has developed a dress code for MBChB and Physician Associate students while on clinical placement.

Read our dress code guidance for clinical placement providers.

Course evaluation

We are open to suggestions for improving this clinal placement, please complete the short placement questionnaire that will be circulated to you via email at the end of your placement at LCH. You can also provide feedback when completing your evaluation forms via the medical school. Please also feel free to let our team know directly how you are finding the placement or to raise any concerns or suggestions with them.